Identifying Home Medication Review candidates: Heart Failure patients who are not on ACE inhibitors

Rationale:

ACE inhibitors reduce mortality and morbidity at any grade of systolic heart failure (NPS News 57), even in patients with asymptomatic disease. A search of electronic records can help identify high-risk patients who may benefit from a medication review. This initiative will assist GPs in improving the quality of their prescribing for heart failure.

Target:

To identify patients who would benefit from a Home Medication Review (DMMR).

CAT Starting Point:

CAT Open - CAT4 view (all reports) loaded

Population Extract Loaded and Extract Pane “Hidden”

Filter Pane open and under the ‘General’ tab ‘Active Patients’ (3x <2 years) selected (this step can be omitted if you want to search for all patients).

Filter Steps

Under the 'Conditions' tab, choose the 'Chronic' tab, and then select 'Heart Failure' under the Cardiovascular section

Under the 'Medications - Heart' tab, in the“ACE or ARB” category, tick “No”.

Click 'Recalculate to apply the filter

Recipe Steps Reports

Hide Filters

Select the "Medications" tab

Select the "Medications per Patient" tab

Click the "with 8+ meds" slice of the graph

Click on Export to show the list of patients

This list will display those patients diagnosed with Heart Failure who are not on ACE inhibitors, but are on more than 8 other medications.

Create a prompt to display in Topbar

Remember you need to be in the CAT4 Daily View to be able to create prompts. Other pre-requisites are:

To start CAT4 in the Daily View, click on the 'Daily View' icon in the dashboard:

Once you have applied the filter(s) and displayed the patients of interest as described above, you can create a prompt that will be shown to all clinicians using Topbar if a patient meeting the prompt criteria is opened in their clinical system. The full guide is available at CAT PLUS PROMPTS and a short guide on how to create prompts in CAT4 can be found at Creating a Prompt in CAT4

To start you have to use the drop-down menu at the bottom of the patient details report and select "Prompt at Consult - Topbar" then click on "Go" to give the new prompt a name.

The name you enter is the prompt text displayed in Topbar, so choose a simple but clear name that tells the clinician seeing the prompt what should be done.

To Export Patient List to Microsoft Excel:

1. Click on the “Export Icon” at the top of the Patient Reidentification window.

2. Click on “Excel”

3. Choose a file name and a location to save to (eg. Create a folder C:/ClinicalAudit/CAT Patient FollowUp)

4. Click “Save”

The steps above will produce a list of patients with contact details in MS Excel which can then be used to:

1. Go back through the individual patient records in the GP Clinical Desktop System (CDS) and update known records